[Integrated care of hidradenitis suppurativa using the example of the EsmAiL project]

The care of patients with hidradenitis suppurativa (HS) is often characterized by delayed diagnosis, fragmented treatment pathways, and limited access to specialized care, allowing the disease to progress to irreversible stages. As the disease progresses, increasing pain, chronic inflammation, and psychosocial burden lead to a substantial reduction in quality of life. Studies indicate that the central problem is rather in the structural deficits in healthcare provision than in a lack of therapeutic options. To address these shortcomings, the EsmAiL project was developed to establish a structured, interdisciplinary, and guideline-based care concept for patients with HS. Specialized acne inversa centers were established to ensure coordinated interdisciplinary and interprofessional care. A central component of the care model was the structured qualification of all healthcare professionals involved. In addition, patients were actively integrated into disease management. In a randomized controlled trial including 553 participants, integrated care resulted in significant improvements in disease activity, pain, quality of life, and psychological burden compared with standard care. The costs of optimized care were only slightly higher than those of standard care in the first year and decrease further in the following year. The results demonstrate that integrated and interdisciplinary care concepts can sustainably improve the management of chronic dermatological diseases. However, long-term implementation will require appropriate structural and health policy frameworks.